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Waterbed Effect Still Present After Doc Tried to Aspirate Abdomen and Came out Dry. Should I Worry?

I am almost four weeks post op now from tummy tuck.i had to see my PS partner beings my doc was out of town for the week. the doctor aspirated one spot on my left side and came out with very very very little fluid. he did not attempt to aspirate any other area but i still have the waterbed effect on my lower abdomen. he said to keep my regular appointment and just wait to see what my PS says about it. should i be worried? how do i know if it is hematoma, seroma or pseudo-bursa.

Doctor Answers (12)

Excess fluid after a tummy tuck

+1

As long as you're not having fevers or severe abdominal pain, it's okay to wait 5-7 days before attempting another drainage of the fluid.  A low salt diet and compression garments may help in the meantime.  However, in my experience seromas resolve after 4-6 weeks of serial aspiration of the fluid.


Baltimore Plastic Surgeon
5.0 out of 5 stars 79 reviews

You have a seroma. It needs to be aspirated.

+1

Even if you had some old blood, you do not have an actively-enlarging hematoma. This is either old blood and serum, or seroma, both of which require the same treatment--aspiration one or more times, compression, and if not resolved in this fashion, replacement of drain, sclerodesis, and (rarely) re-operation for pseudobursectomy.

After a month, if these tissues haven't "stuck-down" yet, they become progressively less likely to do so, so there is some degree of urgency here. That being said, if your surgeon's partner was unable to hit the seroma, this is understandable since he did not do your surgery and does not know the exact thickness of your subcutaneous fatty layer. Most of the time seromas are easy to tap, but not always! Of course, your surgeon's partner did not want to stir up bleeding or go too deep and hit an intra-abdominal organ! So congratulate him for his caution.

Once your doctor returns, you should see him promptly and have this aspirated. It will be done through a mostly or completely numb area, so you need not be worried about discomfort. But it does need to be drained, especially if there is enough fluid for a waterbed effect. Best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 138 reviews

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A seroma after a tummy tuck

+1

It sounds like you have an ongoing seroma problem. If you are asking should you be worried about this being dangerous, then the answer is no.  You can safely wait until your plastic surgeon returns.

Sometimes the layer of fluid is so thin that it is very difficult to aspirated and then it's better to just let it be rather than keep trying and increase the risk infection or injury to one of the surrounding structures.  

While you wait continue to wear your compression garment.

 

Martin Jugenburg, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 182 reviews

Waterbed Effect Still Present After Doc Tried to Aspirate Abdomen and Came out Dry. Should I Worry?

+1

Sometimes a plastic surgeon can attempt to aspirate a fluid collection (seroma) and not get any fluid back.  If there is evidence of a fluid collection but it cannot be aspirated "blindly", an ultrasound examination may demonstrate the presence of the fluid collection, and the radiologist can use the ultrasound to guide them to find and aspirate the fluid.  Rarely, returning to surgery to place a drain may be necessary...although no one looks forward to this option, it is better in the long run than leaving a seroma of significant size alone, as these may form a thick-walled cavity (psuedo-bursa) that will cause a protrusion and require surgical removal.  When your surgeon returns, they can assess your situation, and decide whether to attempt further aspiration(s) or obtain an ultrasound evaluation. 

Robert M. Grenley, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 72 reviews

Aspiration of abdominal seroma

+1

I have experienced this problem as a Plastic Surgeon and when I have been unsuccessful in finding fluid in one area I had to switch to other areas to attempt to find the location of the fluid.  If the movement of the skin would suggest the presence of  fluid because of the water bed feeling of the abdomen, one needs to continue to look for this.  Sometimes ultrasound or CT scanning may need to be utilized to locate this fluid.  Occasionally the fluid may have to be aspirated with the benefit of an interventional radiologic examination, with a subsequent aspiration.  The fluid could also be cultured to be sure that it is not infected.  If it is, a suitable antibiotic or Infectious Disease consult  may need to be considered.

 

The most common complication of  performing abdominoplasty surgery is the creation of a seroma.  This may occur as  often as 25% to 50% of the time, and one needs to look for the fluid if it is suspected.

 

If you have continued concerns about this, always follow up with your Plastic Surgeon.

 

Good luck to you.

 

Frank Rieger M.D.  Tampa Plastic Surgeon

Francis (Frank) William Rieger, MD
Tampa Plastic Surgeon
5.0 out of 5 stars 46 reviews

Seroma after a Tummy Tuck usually DOES have a Waterbed Wave Effect

+1

I sounds like you have a residual seroma. The surgeon should tap at the lowest point of the wave with you standing. Since the area is largely numb it should not hurt. It sounds like the seroma was missed. Arrange to see your surgeon as soon as he gets back. These usually resolve with several painless taps and compression garments.

Peter A Aldea, MD
Memphis, TN

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 63 reviews

A waterbed under my skin?

+1

From your description it seems likely that there is more fluid or that some has accumulated under your abdominoplasty flap. This is one of the more common complications of a tummy tuck. It is common that patients who do develop a seroma will need more than one aspiration. I would contact your plastic surgeon and make another appointment to have him check you. In the mean time wearing an abdominal binder and taking it easy can help prevent reaccumulation of fluid as well. Best of luck, Dr Kerr

Mahlon Kerr, MD, FACS
Austin Plastic Surgeon
5.0 out of 5 stars 90 reviews

Seroma after tt

+1

Small seroma usually resolve. Needle aspiration usually works.  Your doctor may want to try again and if he ccomes up dry just go with compression and close follow up.  He may order an ultrasound also. 

Michael A. Fiorillo, MD
New York Plastic Surgeon
5.0 out of 5 stars 19 reviews

Seroma after Tummy Tuck?

+1

Thank you for the question.

Given your description, it is possible that you do have a seroma present. It may be that the plastic surgeon missed the full collection on the single aspiration attempt. It would behoove you to request another  follow up  visit in the near future to again rule out/aspirate a seroma if present. 

Rarely, a seroma cannot be located clinically;  an ultrasound guided drainage procedure may be indicated.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 781 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.